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PED033302-166 PHOENIX CHILDREN'S HOSPITAL (Active)
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Main Details
Name
PHOENIX CHILDREN'S HOSPITAL
Subdivision Name
Phoenix Children's Southwest Valley - Developmental Pediatrics - Developmental Pediatrics
Type
Children's Hospital
Rural
No
340B ID
PED033302-166
Medicare Provider Number
033302
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/4/2024
Participating Start Date
1/1/2025
Participating Approval Date
11/13/2024
Last Recertification Date
Contacts
Authorizing Official
Phoenix Children's Hospital
Michelle Bruhn, Executive Vice President & Chief Financial Officer
(602) 933-0221
Primary Contact
Phoenix Children's Hospital
Syed Jaffery, Director of Pharmacy Business Operations
(602) 933-5185
Addresses
Street Address
1665 N Avondale Blvd
Suite 201
Avondale, AZ 85392
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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